Most Relevant Information
Provider Data
| NPI Number: | 1003591546 |
| Provider Name: | AMANDA M HACKNEY LPN |
| Entity Type: | Individual |
| Taxonomy Code: | 164W00000X |
| Specialty: | Licensed Practical Nurse |
| License Number: | 30005 |
Most Important Dates
| Enumeration Date: | 06/21/2023 |
| Last Updated: | 06/21/2023 |
Provider Practice Location
1614 RAVINIA RD
CHARLESTON
WV
253141846
Practice Location Phone/Fax
| Phone: | 3048590520 |
| Fax: |
Provider Mailing Location
1614 RAVINIA RD
CHARLESTON
WV
253141846
Provider Mailing Phone/Fax
| Phone: | 3048590520 |
| Fax: |